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-   -   Liver Shunt Repair & BAT (https://www.yorkietalk.com/forums/sick-injured-emergencies-talk/183384-liver-shunt-repair-bat.html)

Lolasmom1211 09-03-2009 04:07 PM
Liver Shunt Repair & BAT
 
My baby girl had her liver shunt repaired in March at UT and I just had her BAT redone for the second time. Her post meal number was 46 which is a huge improvement, but still high. Is this indicitave of MVD or should I give the ring a little more time to do it's job? I've posted her numbers below:

Pre meal:

2/09 43
post surgery - (surgery 3/09)
5/09 10.9
9/09 2.5

Post meal:

2/09 236
post surgery
5/09 132
9/09 46

Thanks! ~~~ Valerie

Patti 09-03-2009 04:16 PM
I don't have any experience with BA's after surgery but I hope someone who does will post. It sounds hopeful.

dwerten 09-03-2009 09:38 PM
Quote:
Originally Posted by Lolasmom1211 (Post 2786164)
My baby girl had her liver shunt repaired in March at UT and I just had her BAT redone for the second time. Her post meal number was 46 which is a huge improvement, but still high. Is this indicitave of MVD or should I give the ring a little more time to do it's job? I've posted her numbers below:

Pre meal:

2/09 43
post surgery - (surgery 3/09)
5/09 10.9
9/09 2.5

Post meal:

2/09 236
post surgery
5/09 132
9/09 46

Thanks! ~~~ Valerie
i would think dr tobias would have done a liver biopsy at time of repair for mvd so you may want to call and confirm this as i believe she does this on all liver shunt surgeries to make sure the dog does not also have mvd

Lolasmom1211 09-04-2009 04:02 AM
Quote:
Originally Posted by dwerten (Post 2786609)
i would think dr tobias would have done a liver biopsy at time of repair for mvd so you may want to call and confirm this as i believe she does this on all liver shunt surgeries to make sure the dog does not also have mvd
Dr. Tobias did do a biopsy and it was normal. It was my impression that they could still have MVD, even with a normal biopsy. Am I mistaken? I hope so. I have never heard that the biopsy would conclusively prove no MVD. I will certainly ask. I sure hope you are right because it would save me a lot of worrying about her food, snacks, vaccines, etc. I will keep you posted. Thanks ~~~ Valerie

dwerten 09-04-2009 05:02 AM
Quote:
Originally Posted by Lolasmom1211 (Post 2786751)
Dr. Tobias did do a biopsy and it was normal. It was my impression that they could still have MVD, even with a normal biopsy. Am I mistaken? I hope so. I have never heard that the biopsy would conclusively prove no MVD. I will certainly ask. I sure hope you are right because it would save me a lot of worrying about her food, snacks, vaccines, etc. I will keep you posted. Thanks ~~~ Valerie
yes i believe the biopsy confirms this whether they have mvd or not and i think it takes some time for bats to go to normal as the constrictor closes as it closes slowly - it is acquired shunts that can happen not mvd i believe after a shunt repair so you may ask about that as well

Lolasmom1211 09-04-2009 05:08 AM
Quote:
Originally Posted by dwerten (Post 2786794)
yes i believe the biopsy confirms this whether they have mvd or not and i think it takes some time for bats to go to normal as the constrictor closes as it closes slowly - it is acquired shunts that can happen not mvd i believe after a shunt repair so you may ask about that as well
I've just called UT and left a message. I'm sure with it being a holiday weekend, they may not get back with me until next week. I'll post what they say! Thanks ~~~ Valerie

TLC 09-04-2009 05:53 AM
Quote:
Originally Posted by Lolasmom1211 (Post 2786801)
I've just called UT and left a message. I'm sure with it being a holiday weekend, they may not get back with me until next week. I'll post what they say! Thanks ~~~ Valerie
Good, I think UT would have the best answers for you ;)

dwerten 09-04-2009 07:58 AM
Quote:
Originally Posted by Lolasmom1211 (Post 2786801)
I've just called UT and left a message. I'm sure with it being a holiday weekend, they may not get back with me until next week. I'll post what they say! Thanks ~~~ Valerie
that is great let us know :) always wanting to learn more about this since it affects our breed so much :(

camillek 09-04-2009 02:27 PM
Quote:
Originally Posted by Lolasmom1211 (Post 2786801)
I've just called UT and left a message. I'm sure with it being a holiday weekend, they may not get back with me until next week. I'll post what they say! Thanks ~~~ Valerie
Can you give me a number/name to call for Dr. Tobias' office? I left a message at UT and nobody returned my call. I appreciate your assistance.

Thanks

Lolasmom1211 09-04-2009 03:00 PM
Quote:
Originally Posted by camillek (Post 2787493)
Can you give me a number/name to call for Dr. Tobias' office? I left a message at UT and nobody returned my call. I appreciate your assistance.

Thanks
I called the main number today (865-974-8384) and explained I was a patient from March and left her a voice mail. I did not hear back, but my vet got a written report back from her this morning. That's even better because I won't forget what she said! Good luck!

Lolasmom1211 09-04-2009 03:07 PM
My vet received a written report from Dr. Tobias this morning and these are just excerpts from it:

About passing the denamarin whole -
"As noted in your communication, her bile acids are improved at 2.5 and 46
(9/2/09) but still not normal. You also noted that she has been passing the
denamarin almost unchanged. I agree about discontinuation of the lactulose.
Since her chemistry panel is normal and she has gained weight, she should do
well on the liver diet alone...."

"Based on Lola's bile acids and bloodwork, I would suspect that she has
microvascular dysplasia secondary to congenital portal hypoplasia. The only way to know for sure is to repeat the scintigraphy and liver biopsy...."

I don't think she recommends repeating the Scintigraphy and biopsy again, and my vet agrees. We will just maintain Lola on a good, solid low protein diet. She has done super since the surgery and we will continue with what we are doing. ~~~ Valerie, "Lola & Harley"

dwerten 09-05-2009 10:08 PM
Quote:
Originally Posted by Lolasmom1211 (Post 2787557)
My vet received a written report from Dr. Tobias this morning and these are just excerpts from it:

About passing the denamarin whole -
"As noted in your communication, her bile acids are improved at 2.5 and 46
(9/2/09) but still not normal. You also noted that she has been passing the
denamarin almost unchanged. I agree about discontinuation of the lactulose.
Since her chemistry panel is normal and she has gained weight, she should do
well on the liver diet alone...."

"Based on Lola's bile acids and bloodwork, I would suspect that she has
microvascular dysplasia secondary to congenital portal hypoplasia. The only way to know for sure is to repeat the scintigraphy and liver biopsy...."

I don't think she recommends repeating the Scintigraphy and biopsy again, and my vet agrees. We will just maintain Lola on a good, solid low protein diet. She has done super since the surgery and we will continue with what we are doing. ~~~ Valerie, "Lola & Harley"
WHAT ???? did she not biopsy the liver when correcting the shunt if so why not ? I always thought tobias did this when correcting the shunt to make sure mvd was not also a diagnosis - i am confused and disappointed :(

Lolasmom1211 09-06-2009 05:05 AM
Dr. Tobias did biopsy the liver when she corrected the shunt and it came back normal. It is a little confusing to me but Lola seems to be doing so well I will just keep her on a low protein diet and she should do fine. It has been explained to me (in very simple terms, so I could understand) that this could be acquired shunting that developed after the ring was put on the large shunt. Apparently, this sort of MVD causes few problems and is easily managed with diet. We'll see. Lola has never had any neurological symptoms of a shunt except for small growth and lethargy, and she has gained weight and is full of energy since her surgery. Keeping her on the low protein diet is easy!

dwerten 09-06-2009 06:09 AM
Quote:
Originally Posted by Lolasmom1211 (Post 2789255)
Dr. Tobias did biopsy the liver when she corrected the shunt and it came back normal. It is a little confusing to me but Lola seems to be doing so well I will just keep her on a low protein diet and she should do fine. It has been explained to me (in very simple terms, so I could understand) that this could be acquired shunting that developed after the ring was put on the large shunt. Apparently, this sort of MVD causes few problems and is easily managed with diet. We'll see. Lola has never had any neurological symptoms of a shunt except for small growth and lethargy, and she has gained weight and is full of energy since her surgery. Keeping her on the low protein diet is easy!
great news whew i was worried there --yes acquired shunting is a possibility once corrected but she should be ok :) you are a great mom to have taken her there and to stay so informed --good job :)

Lolasmom1211 09-06-2009 01:11 PM
Quote:
Originally Posted by dwerten (Post 2789287)
great news whew i was worried there --yes acquired shunting is a possibility once corrected but she should be ok :) you are a great mom to have taken her there and to stay so informed --good job :)
Thank you...it's easy to take care of these little ones when they are so sweet!

iwannalollipop2 10-11-2009 09:26 AM
Hmm, well we just got Lacy's results back (we did the test after only two months because of vomiting, just to see what was going on), and she actually came back completely in the normal range. She was about as high as Lola before the surgery. Since it's been longer than six months for Lola, I can't imagine the values could only just now be coming down. Like you said, the biopsy isn't really indicative of having MVD (they're wrong all the time). One thing Dr. Bohling (coworker of Dr. Tobias, and the vet who did Lacy's surgery) told us was that sometimes after the surgery the dogs get Multiple Acquired Shunts, but this is rare because of the user of the constrictor ring. They aren't correctable, but it's doubtful that she has them. Anyway, it's a good thing the numbers came down that much anyway, and hopefully she starts to get even better!

Lolasmom1211 10-11-2009 09:47 AM
Quote:
Originally Posted by iwannalollipop2 (Post 2834458)
Hmm, well we just got Lacy's results back (we did the test after only two months because of vomiting, just to see what was going on), and she actually came back completely in the normal range. She was about as high as Lola before the surgery. Since it's been longer than six months for Lola, I can't imagine the values could only just now be coming down. Like you said, the biopsy isn't really indicative of having MVD (they're wrong all the time). One thing Dr. Bohling (coworker of Dr. Tobias, and the vet who did Lacy's surgery) told us was that sometimes after the surgery the dogs get Multiple Acquired Shunts, but this is rare because of the user of the constrictor ring. They aren't correctable, but it's doubtful that she has them. Anyway, it's a good thing the numbers came down that much anyway, and hopefully she starts to get even better!
Hooray for Lacy!!!! I am so happy her numbers came back normal. We are treating Lola like a MVD baby and she is doing well. She has gained weight and has lots of energy. We are just thankful that we discovered this early on and had the surgery done to correct the large shunt and will watch her diet accordingly! Give Lach a big kiss on her nose from us! ~~~ Valerie


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